Vital signs as biomarkers of early clinical deterioration in pediatric emergency departments: physiology, interpretation, and innovations: a narrative review.

Authors

• Mohamed Alsabri
• Marina Ramzy Mourid
• Amr R Saleh
• Temitomi Jane Oyedele
• Israa Magdy Ata
• Sara M Darawish
• Aanal Patel
• Faher Al Rouh
• Lauren A Carr, Department of Emergency Medicine, St. Christopher's Hospital for Children, PhiladelphiaFollow

Document Type

Article

Publication Date

1-8-2026

Abstract

BACKGROUND: Early recognition of pediatric deterioration is difficult because age-dependent physiology and compensation mask early shock and safety risks. This narrative review compares vital-sign (VS) biomarkers (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature) with laboratory markers and clinical indicators.

METHODS: We searched Embase, Pubmed, and guideline repositories to August 2025 for pediatric studies from emergency, inpatient, and critical-care settings. We summarized accuracy, timeliness, and implementation issues, prioritizing cohort and implementation evaluations.

RESULTS: Age-adjusted, repeated, and continuous analyses of VS—especially multivariate approaches such as shock index pediatric age-adjusted and heart-rate-characteristics analytics—outperformed single thresholds, often anticipating ICU transfer or sepsis by hours. Laboratory biomarkers provided diagnostic specificity for defined syndromes but were slower and unsuitable for continuous surveillance. Composite scores (e.g., PEWS, ED-PEWS, National PEWS) showed moderate to high discrimination yet performed best when integrated with trends and standardized escalation pathways.

CONCLUSION: VS biomarkers, leveraged as dynamic trends and combined with context, enable earlier, safer detection of pediatric deterioration than static thresholds or isolated laboratory tests. Priorities include validating continuous models beyond NICUs, ensuring equity and calibration across different ages and comorbidities, and testing wearable sensors and EHR-embedded alerts in pragmatic trials that measure timeliness, unintended harms, and patient-centered outcomes.

CLINICAL TRIAL NUMBER: Not applicable.

Publication Title

Int J Emerg Med

Volume

19

Issue

1

First Page

6

Last Page

6

Recommended Citation

Alsabri, M., Mourid, M., Saleh, A., Oyedele, T., Ata, I., Darawish, S., Patel, A., Rouh, F., & Carr, L. (2026). Vital signs as biomarkers of early clinical deterioration in pediatric emergency departments: physiology, interpretation, and innovations: a narrative review.. Int J Emerg Med, 19 (1), 6-6. https://doi.org/https://doi.org/10.1186/s12245-025-01107-8